Title: A Survey of Aspirin Desensitization Practices Among Allergists and Fellows in Training in the United States
Abstract: RATIONALE: Progesterone autoimmune dermatitis (PAD) is a complex syndrome associated with hypersensitivity reaction to exogenous or endogenous progesterone, often with cyclical symptoms correlating with the menstrual cycle.Symptoms can range from dermatitis to anaphylaxis and an increasing number of cases have been reported after the advent of in vitro fertilization (IVF), during which women are exposed to supraphysiological levels of progesterone.We present here a large case series of PAD with novel approaches to skin testing and progesterone desensitization.METHODS: Seventeen cases of PAD referred to the BWH were reviewed.Symptom presentation, diagnostic modalities, desensitization protocols, and outcomes were analyzed.Indications and efficacy of oral and intramuscular (IM) desensitization protocols are evaluated.RESULTS: Symptoms were heterogeneous and included cyclical dermatitis, urticaria, angioedema, and bronchospasm.Eight patients (47%) reacted to endogenous progesterone with menstruation or pregnancy triggering symptoms.In the other nine patients (53%), symptoms were triggered by exogenous progesterone used for contraception or fertility treatment.Of patients skin tested, 9/15 (60%) had positive skin prick or intradermal testing to progesterone.Five patients were desensitized to progesterone: one IM and four oral.One patient failed the first desensitization, but was successfully desensitized with an adapted protocol.Desensitization resulted in symptom relief and viable pregnancy through IVF in one case.CONCLUSIONS: This is the largest case series of PAD patients in the literature to date with successful outcomes.PAD presents heterogeneously and skin testing can be utilized for diagnosis.Women with cyclical allergic symptoms and infertility should be evaluated for PAD and possible progesterone desensitization.